(WJHL) – COVID-19 outbreaks can return to long-term care facilities with the stealth of a burglar.

That’s something the folks at Lee Health and Rehabilitation in Pennington Gap, Va. know all too well.

“They were just getting ready to open up for visitation after several months without any cases when we found out that there was a case,” Jennifer Eddy, a spokeswoman for Lee said Wednesday.

The Virginia Department of Health (VDH) had moved the outbreak that started July 4 and had only infected 13 staff and residents into its “pending closure” status several weeks back.

But earlier this month, the 110-bed facility’s name showed back up in “outbreak in progress” status — and with a case count nearing 40. Eddy said a resident began showing symptoms and the facility immediately got that person tested.

When that came back positive, the center tested all staff and residents. “Unfortunately there were a number of cases that came back flagged.”

Since then, the rural community has seen case counts increase at its long-term care center — which has also recorded at least one death.

As of Wednesday, the case count — unlike Tennessee, VDH doesn’t separate resident and staff cases in its numbers — had risen to 73 — 53 residents and 20 staff.

Eddy said all VDH and CDC guidelines are being followed. Positive staff are quarantining at home. Positive residents are in a protected unit.

And residents who’ve come in recently from another facility or a hospital, along with those who have had a roommate that tested positive or give Lee other reason to be concerned, are in a “mid-tier watch area.”

Residents who have tested negative and give no other causes for additional concern are in their own separated area.

‘Incredibly difficult to pinpoint’

Lee’s experience offers a cautionary tale about how easily COVID can get into long-term care facilities when community spread is occurring, and about how a facility can seem to have it licked only to see it return.

Community spread in Lee County has grown faster the past two weeks than it has regionwide.

Asked how the virus got back into the facility after so many weeks without any cases, Eddy said she didn’t have a good answer.

“We have been working with VDH to do all the contact tracing but it’s incredibly difficult to pinpoint exactly where and how an outbreak got started,” Eddy said.

She said COVID can “hide itself in asymptomatic people” because of its incubation period — and the fact that a good percentage of people who contract it never show symptoms and so have no clear reason to be tested.

“That’s been the biggest challenge I think in these kinds of settings and atmosphere,” Eddy said.

The setback was doubly disappointing because Lee was on the verge of lifting some restrictions that had been necessary but also had made day-to-day life less enjoyable.

It’s incredibly discouraging for staff who’s been working very very hard to get back to some level of normalcy and engage the residents in ways that make life fun and enjoyable in these residence facilities,” Eddy said.

Lee is among several Southwest Virginia facilities on the “outbreak in progress” list. The most recent regional outbreak started Sept. 28 at Commonwealth Senior Living in Abingdon.

Since then, 35 people have tested positive and at least one has died. Virginia uses an asterisk if case numbers or death numbers are at least one but lower than five.

The community spread challenge

The hardest-hit facility in Southwest Virginia has been Valley Health Care in Chilhowie. An outbreak that began Aug. 30 has resulted in 173 cases and 15 deaths. Those are the highest numbers for any outbreak in progress and the case total is the second-highest out of several hundred Virginia facilities that have had outbreaks.

Tuesday, their administrator, Jason Lindsey, told News Channel 11 they had just two positive, non-recovered residents left.

Lindsey sounded hopeful that Valley was nearing a return to some semblance of normalcy. But he said he knows the virus — which is known to be fatal to roughly 15 percent of long-term care residents who contract it — could easily get back into the facility.

That possibility increases as the virus circulates at greater rates within the community, Mount Rogers Health District Director Dr. Karen Shelton told News Channel 11 last month.

In words that Eddy nearly echoed Wednesday, Shelton said COVID is generally recognized late in nursing homes and can “come in and then spread and overtake more than half the facility before you even know it’s there.”

And as community spread increases — it has nearly doubled in Southwest Virginia over the past month — the virus finds itself with more opportunities to penetrate the most vulnerable populations.

A month ago, the average number of people per 100,000 testing positive daily throughout Southwest Virginia was 12.03 (based on a 14-day rolling average). Wednesday, that number was 22.93.

“People are free to go out and do as they wish, but being mindful of that spread of disease,” Shelton said. “It is really hard for people to fathom where that spread goes and how many people are affected by a community with widespread transmission.”

In Southwest Virginia, at least 32 of the 56 deaths recorded since Sept. 3 have been people infected from long term care outbreaks. The number could be higher due to the exact numbers at Lee, Commonwealth and a Scott County facility being unknown.

Those are people who, while they may not have been in the greatest health, had the capacity to enjoy simple things like bingo with fellow residents, a card or letter written with love, and the splendid fall colors that have blanketed the region’s hills and mountains.

As Shelton said, “it spreads and then it has a devastating effect, and the poorest outcomes are from our long term care facilities.”